MEDICARE: GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	070802	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629015078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC

Provider Business Mailing Address
First Line	:	850 S 5TH ST
Second Line	:	GOOD SHEPHERD PLAZA
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-3308
Country	:	US
Telephone Number	:	610-776-8303
Fax Number	:	610-778-9272

Provider Business Practice Location Address
First Line	:	601 SAINT JOHN ST
Second Line	:	CONRAD W RAKER CENTER
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-3233
Country	:	US
Telephone Number	:	610-776-3199
Fax Number	:	610-776-3143

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL SPIGEL
Credential	:
Telephone Number	:	610-776-3130

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	09/21/2020

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